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TODAY’S DOSE OF HONESTY

A consumer’s guide to weight loss drugs without the stab

With all the interest in injectable GLP-1 agonist weight loss drugs, like semaglutide (Ozempic), it’s important to understand that 5 other medications are FDA-approved for weight loss. They each have their own risk/benefit profile, and many people are unfamiliar with them. So, this week, let’s talk about Qsymia.  

Qsymia was FDA-approved for weight loss in 2012 and comes in pill (oral) form. It has an interesting back story: Scientists discovered that both of its ingredients—topiramate (often used to reduce the risks of seizures) and phentermine (a stimulant)—resulted in weight loss; however, typical regular doses of phentermine and topiramate produced significant side effects. (You may recall news headlines about Phen-fen in the 1990s that linked its use—at those regular doses—with a risk of valvular heart disease.)

Enter a key tenet of pharmacology: Dose matters. With that in mind, the developers of this drug conducted tests to determine what dose would result in a “positive” outcome (adequate weight loss) with minimal “negative” effects. They found that in lower doses, there was a sweet spot where significant weight loss was achieved, and the likelihood of significant side effects was reduced.     

Available only by prescription, Qsymia is a pill you take every morning with or without food. It works mainly by targeting brain centers that are involved in satiety and hunger. There are 4 dosing levels. Typically, the initial dose is taken for 2 weeks, then a 2nd-level dose is taken for 3 months; dosing is then reevaluated.

Very common side effects involve paresthesia (or pins-and-needles sensations in the hands and feet), constipation, and/or dry mouth, which resolve after lowering the dose and/or discontinuing the medication. There is a black box warning on Qsymia for potential birth defects if pregnancy occurs while taking the drug; therefore, using effective contraception is critical for reproductive-aged women. There’s a rare but slightly increased risk of kidney stones and brain fog with higher doses, but the brain fog risk disappears with discontinuation of the drug. As always, the potential for drug interactions exists, especially for people taking certain psychiatric meds (anti-anxiety or antidepressant medications). This possibility should be explained.

Qsymia is widely available, but whether or not insurance covers it depends on individual insurance plans. The cost could be $600+ a month if it’s not covered. 

Bottom line: Like injectables, Qsymia is an Rx-only drug, and it’s not as effective as semaglutide. But if you’re not comfortable with shots, Qsymia is one of the more effective oral weight-loss medications. Talk to your doctor about whether it’s an option for you.

SYMPTOM SOLUTIONS

Let’s hear it for FAT!

Am I cheering fat? Yes. In fact, I eat fat every day in my morning smoothie. Believe it or not, consuming dietary fat daily is not only NOT bad for you, but it’s vital to the body’s operating system, providing it with energy and supporting cell function. And it can bolster your health in numerous other ways too…IF you choose the right types of fat. So, on today’s TO-DO list: Memorize the MUFAs!

What’s a MUFA?

First, some nutritional science. MUFAs (say “MOO-fahs”) are MonoUnsaturated Fatty Acids. Found in plants, monounsaturated fats are fat molecules that have just one unsaturated carbon bond. Oils that contain monounsaturated fats are typically liquid at room temperature but start to turn solid when chilled.

By contrast, saturated fats—such as butter, lard, and the fat on meats—remain solid at room temp. Naturally occurring trans fats are produced in the gut of some animals; foods made from these animals (such as milk and meat products) may contain small quantities of these fats. Artificial trans fats (or trans fatty acids) are produced by adding hydrogen to liquid vegetable oils to make them more solid; these are found in cakes, cookies, breads, and other prepackaged foods.

So, what makes MUFAs better fats?

All fats provide 9 calories per gram. And consuming high amounts of calories—no matter what the source—can lead to weight gain, overweight, and obesity. That said, MUFAs in particular can have a very positive effect on your health when eaten in moderation. They may help:

• Reduce bad cholesterol levels in your blood, which can lower your risk of heart disease and stroke, especially if you’re replacing saturated fat. Various studies have shown that a high intake of monounsaturated fats can reduce blood cholesterol and triglycerides.

• Lower breast cancer risk. Research on olive oil specifically found that people who consume more of it have lower rates of breast cancer. One large study of 642 women found that those with the highest amounts of oleic acid (a MUFA abundant in olive oil) in their fat tissue had the lowest rates of breast cancer.

• Decrease inflammation in the body. Researchers found that high-MUFA diets reduced inflammation in patients with metabolic syndrome, compared to high-saturated fat diets. Other studies have shown that people who eat a Mediterranean diet high in MUFAs have significantly lower inflammatory chemicals in their blood, such as C-reactive protein and interleukin-6.

• And they may help you lose weight. A diet with moderate-to-high amounts of MUFAs may also help with weight loss, as long as you aren’t eating more calories than you’re burning. Studies have shown that when calorie intake remained the same, diets high in MUFAs led to weight loss similar to low-fat diets. And when you eat healthy fats, you feel fuller faster. They fill you up and satisfy you, as opposed to processed carbs, which often leave you craving more.

While other lifestyle factors may be at play in these instances, it still makes sense to replace the saturated fats in your diet with MUFAs. The great news? They’re pretty delicious—no arm-twisting necessary! Fatty fish (think salmon and tuna), eggs, and red meat contain MUFAs, but I generally try to stick with the (very tasty) plant-based options.

Plant-based MUFA-rich foods

• Olives and olive oil

• Other oils such as canola, peanut, safflower, sunflower, & sesame

• Avocados

• Peanut butter & other nut butters

• Some nuts, including almonds, hazelnuts, walnuts, & pecans

• Some seeds, including pumpkin, sunflower, & sesame

I am a big fan of olive oil and avocados (the secret ingredient that makes my smoothies so creamy!). So, here’s my advice as a nutritionist and MUFA fan: As long as your overall calorie intake stays in the sensible range, get to know the MUFAs and make them a regular part of your eating plan.

Speaking of healthy food…

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COMMUNITY

“Is flossing necessary? I don’t do it as often as I should.”

I am not sure anyone would wear a T-shirt that says, “I LOVE to floss my teeth!” But consider this: The connection between oral health and overall health has long been established. And in this age of straightening and whitening—in other words, cosmetic dental improvements—it bears repeating: No matter how sparkling white they are, if you don’t keep your teeth and gums in top shape, you put yourself at risk for a host of serious conditions. Here’s information from the U.S. National Institute of Dental and Craniofacial Research (NIDCR):

• During the last four decades, researchers have uncovered connections between oral disorders, such as periodontal (gum) disease and tooth decay, and numerous conditions including diabetes, dementia, cardiovascular disease, preterm birth, HIV, and even cancer. These connections suggest that having oral problems may increase the risk of developing or worsening a systemic condition, and vice versa.

• What causes these connections isn’t clear. In some studies, scientists found periodontal disease-causing bacteria in the diseased part of the body, suggesting these bacteria travel around and trigger illness beyond the mouth. There’s also evidence that periodontal inflammation, generated by the immune system’s response to excessive bacteria in the gums, can worsen inflammation in other parts of the body, which may contribute to certain diseases. On the flip side, inflammation due to conditions like heart disease and diabetes may worsen periodontal problems.

• Periodontal disease and chronic systemic conditions like heart disease, stroke, and diabetes also share risk factors, such as smoking, poor diet, obesity, high blood pressure, and high LDL, the “bad” cholesterol. Having one or more of these risk factors may increase the likelihood of both oral and systemic diseases.

• Finally, the mouth is the gateway into the digestive and respiratory tracts. Infections, ulcers, pneumonia, and possibly even cancer may result when disease-related microbes are inhaled or ingested.

That’s a lot to swallow—so let’s go back to the original question: Should you floss? The answer is a qualified yes. Brushing is important, but there are portions of the teeth and gums—particularly the spaces in between teeth—that a regular brush can’t reach. Plaque and calculus can build up in these areas and cause gingivitis and periodontal disease. Flossing is a simple, low-cost way to clean all sides of your teeth and protect your teeth and gums. Here are more pointers from the NICDR:

Check your flossing technique. Your dentist or dental hygienist can offer tips and tricks that might make your flossing more effective.

Use a piece of floss at least 18 inches or longer, with the unused floss wrapped around the middle and ring fingers of both hands. Longer floss is easier to control than a short piece.

Don’t pop your floss. Snapping the floss through the contact areas between teeth can cause pain and damage the delicate tissue between the teeth. Use a gentle sawing motion to slide the floss through the contact.

Try a floss threader if you have tight contacts between your teeth; it will help get the floss where it needs to go.

What if you just hate to floss? Fortunately, there are other effective ways to remove plaque from between your teeth, such as using a water flosser or interdental brushes (hence the qualified yes). The important thing is to disrupt plaque before it hardens into calculus. Talk to your dentist about whether one of these flossing alternatives might work for you.

ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has written several books, including the best-selling book, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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